延迟性冠脉介入及静脉溶栓对急性心肌梗死预后的影响

Comparison between delayed percutaneous intervention and intravenous thrombolysis therapy in patients with acute myocardial infarction (AMI)

目的:对比研究延迟经皮冠状动脉内成形术(PTCA)及支架植入术(ICS)与静脉溶栓术(IT)对急性心肌梗死(AMI)患者近期及远期预后的影响。方法:36例初次AMI患者被分为2组,即延迟PCI组(A组)16例、静脉溶栓成功组(B组)20例。结果:(1)住院期间A组和B组平均住院天数(d)、再发不稳定心绞痛(％)、非致死心肌梗死(％)、心源性死亡(％)、住院期死亡及复合终点事件(不稳定性心绞痛、心肌梗死和死亡的总和)(％)、室壁运动异常积分指数等指标之间比较无明显差异(P>0.05);(2)随访期间A组左室扩大(％)、室壁瘤形成(％)、死亡及复合终点事件(％)、再狭窄率(％)等发生率低于B组(P<0.05)、存活率(％)及射血分数(％)明显高于B组(P<0.05)。结论:失去溶栓时机或溶栓失败的AMI患者积极行延迟PTCA及支架植入治疗,对改善近期及远期预后是有益的。

Objective: To compare the short and long term clinical prognosis of delayed percutaneous intervention (PCI) and intravenous thrombolysis (IT) therapy in patients with acute myocardial infarction (AMI). Methods: A total of 36 patients with AMI were divided into delayed PCI group (group A,16 cases),IT therapy group (group B,20 cases). Results: (1)No significant difference was observed in hospital cardiac events between group A and group B(P> 0. 05); (2)During follow-up period (mean 190+23. 1 days),the occurrence rates of cardiac events and cardiac death, the restenosis rate of infarct related artery were lower in group A than that in group B(P<0. 05). The survival rate and LVEF of group A were higher than that of group B (P<0. 05). Conclusion:Delayed PCI for patients with AMI is a good choice of revascularization and a better outcomes of improving short and long term clinical prognosis.